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Towards an Aging in Place 2.0 vision

Sun, 09/19/2010 - 10:39 - Laurie Orlov

Nice goal, but how to age in place? In the pendulum swing of all 'aging in place' all the time, a murky target has been set, but the tactics are more like a meandering and treacherous hiking trail than a well-marked pathway. Some of us will pick up and leave for a more service-rich environment in advance of need, usually at an age or level of actual or anticipated limitations. But these service-rich environments, typically Continuing Care Retirement Communities (CCRCs), represent a relatively small proportion of older age range of the 65+ population. And CCRC moves require sale of a house, downsizing of possessions, and a move that can be a traumatic change. In addition, these 'enclaves' (as described in a recent NY Times article) are not without financial issues. Certainly the word 'continuing' is a misnomer unless one counts a campus change to a smaller space for both person and possessions as not really moving.

We need a vision -- here's a good start. MetLife's Mature Market Institute deserves a round of applause: last week they published a report (with consultant Louis Tenenbaum) that should push us to envision the path for this elusive aging in place goal. In Louis' Aging in Place 2.0 world, we're not moving to a destination where we will likely experience 'overcare', that is access and cost of more services than we need for much of our time there -- think CCRC. And we won't need to suffer from 'undercare' -- that is we can't find and don't have the services when they are most needed. Or we can't find them on behalf of an aging parent dwindling away in increasing isolation and frailty in a condominium in Florida, surrounded by other frail seniors also desperately in need of help. So what will be different in an Aging in Place 2.0 world?

The vision is tantalizing -- coordinated care, in our home. From the report: "In AiP2.0, people live in the home of their choice equipped with tools and design features that support independence and assure that individuals and their caregivers are safe. Preventive medical care and wellness assistance encouraging self-management of health is available. Care, meals, supplies, transportation to appointments, and activities as well as social connections, etc. are all managed easily." What struck me is how management of this coordinated care will be provided through "neighborhood care hubs, in which passive and active devices connect homes to family, friends, and care managers who staff them." Neighborhood care hubs could be located in senior or wellness centers, or, in my view, these neighborhood care hubs could also be provided by nearby CCRCs on behalf of the surrounding community. The care hub's monitoring system -- think response center -- evolves into a management system in which trained and qualified staff coordinate and dispatch a wide variety of resources to subscribing participants.

From a patchwork of responders to a management system. So how to transition beyond today's unintegrated call center responders for individual product subscriptions -- like personal emergency response systems, remote activity monitoring, medication management, or chronic disease management tools that transmit to doctors? And how to incorporate the care coordination service skills already present in today's CCRCs? As the MMI report notes, this requires a database-driven ability to 'calibrate care' in which the right amount of information is known about an individual in order to prompt the care manager in the neighborhood care hub (or perhaps prompt the 'virtual' care manager) to correctly respond to online inquiries, alerts, or calls. These alerts enable the neighborhood care hub to enlist the right service as needed, notifying pre-identified family and contact points that are previously specified. You may ask, isn't this a PHR or an EHR database or system? While they could be useful data sources (if they were current, for example, with a list of prescribed medications), I don't believe they are necessary for the neighborhood care hub to function.

So who builds the 'management' system? Think back to the enterprise world of individual transaction systems -- material planning, procurement, manufacturing, customer management -- which were ultimately linked together into an 'enterprise' management system that became an ERP (Enterprise Resource Planning) integrated suite. Today we have the basic elements for neighborhood care hubs locked away in individual transaction systems -- for example, Philips, VRI, Healthsense, GE QuietCare, Bosch's Health Buddy. These all have elements of the neighborhood care hub data set, potentially organized into geographic zones, shared with other local care services operating in those zones. Think about home care franchise territories, senior center membership lists, meal delivery maps, transportation subscriber lists, health care patient databases, or community church membership lists. Combine that with the plethora of senior care directory search tools on the market today. If such combined data sets could be searched by staff using these directory search tools -- now that's a powerful foundation to help achieve the AiP 2.0 vision.

Opt in, subscribe, share, access. Vendors who share the 'neighborhood care hub' vision could assemble opt-in local databases about people and resources into a repository with rules for matching AiP 2.0 clients to required resource. They could do this with little difficulty, given their directory systems and call center response databases, integrating on behalf of local participants. Subscription fees would be paid by individuals in the community, family members on their behalf, and resource providers for the ability to include their information into such a neighborhood care hub system. Care hub managers would have tools to access that system when needed. Eventually, vendors would see a need and benefit to link systems together through some type of interface, selling subscription access to a hosted (Software as a Service) integrated Care Resource Planning (ICRP) system sold to home care agencies, senior housing organizations, health care providers, and local social services organizations.

Crazy, huh? That's what an AiP 2.0 vision document can inspire. :)

Thanks, MetLife and Louis. Now we need your additional inspired thoughts, including how the roles of responders, CCRC staff, health or other service providers would need to change to participate in an AiP 2.0 world.

Eldersync is doing that right now! Eldersync is a coordination-of-care ecosystem where all of the disparate data, devices and roles come together. Check it out and see what it can do! We're currently looking for testers.

Very interesting observations. i am creating a mapping tool which will function to accumulate individual heretofore separate private security patrols into a map layer of secondary responders to be accessed when required. Geo coded alerts will not only have access to PSAP data base but the secondary responders as well.Obvious first mapped were Universities, Organized Neighborhoods, Retail Mall and Campus and Tax Allocation Districts

Your analogy to ERP systems is spot-on. Today, systems are all independent. Another place to look is the finance and airline industries, where enormous volumes of data are moved instantly among different, and often competing, companies and where data security is mission-critical.

There are (at least) three components to the revolution you mention: technical development, data integration, and changes in care provider practices. My assertion: this will not be driven by the VA or Medicare, but rather by the private pay, aging in place market.

You mention the home care market but only as a local data hub. I strongly believe that home care client records can and should be available via web to family members, the client's health care providers, and other authorized users. So home care agencies are the source of another large amount of highly valuable data.

At my home care company (Caring Companion Connections, http://www.CaringCompanion.Net based in Concord MA), we developed our own system for web-based, private, secure family portals where our caregivers post reports for remote family members to view. When we are not on site, we use fall monitors and other devices for both data capture and client monitoring. We provide access to our system for the client's other health care providers and families have seen great value in that. We also use fall monitors, remotely monitored med dispensers, and other technology to improve the quality of care and to reduce its cost.

Outstanding! What we need is more collaborators to bring this vision to fruition. I’ve also been working on a company with a similar if not identical vision: To create, in conjunction with partners, a comfortable and safe home environment for independent living. To enhance livability, accessibility, flexibility of the client's home. To help prepare the client for future lifestyle changes. To create connectivity in conjunction with all community services.

I'm thrilled to see this topic! Starting back in the late 1990s, I was organizing neighborhoods in Concord, MA for both emergency preparedness response (mutual assist by neighbors) and social cohesiveness -- our neighborliness in suburbia having collapsed somewhere along the way.

Back then, more than 10 years before I was in the elder care field full time, it was apparent to me that the neighborhood was a viable and efficient model for all types of care delivery to elders aging in place (not sure the term "aging in place" existed back then).

If I could have easily seen that back then, knowing as little as I knew back then, then others with far more knowledge of the elder situation could have been light years ahead of me. But no -- everyone I talked to about this looked at me like I had two heads.

Resistance to change is such a powerful force. One thing that overcomes such resistance is the potential for profit. If/when neighborhood hubs can be seen as a commercial opportunity they are, then we will see them develop. I agree with those here who say we will not see this kind of paradigm shift come from governmental sources.

Both you and Mr. Reynolds are correct in pointing to data integration as the key enabler for the realizable vision of AiP 2.0.

However, based on decades of experience integrating data within and across corporate/government/academic/etc. operational systems (including ERP), it will require a valid methodology (process) and federated data architecture to accomplish this goal.

That being said, the daunting technical challenges in this type of endeavor are easy compared to the culture, process and political challenges associated with integrating data from various fiefdom silos, even within the same organization, much less cross-organization.

While an offering such as ElderSync (great vision, BTW) can be a source of some pre-integrated data, the overall AiP 2.0 concept, by definition, requires integration of disparate data sets from multiple non-profit, for-profit and government entities. It can take multiple years to integrate the data from a few operational systems within the same corporation, even with the CEO wielding a big stick as motivation. How can you motivate multiple players, some of whom are direct competitors, to integrate their data?

A big carrot helps, and in this case, it will need to be a compelling value proposition around the network effect of integrated data, as with the airlines, as well as a shared revenue stream to the data providers.

I anticipate interesting discussions regarding the relative proportions of that revenue stream allocated to each data provider...

Now is the time for someone to step up with "a compelling value proposition" for a group of strategic AIPT partners who could benefit from an innovative AIP 2.0 marketing strategy and "a valid methodology (process) and federated data architecture to accomplish this goal."

It is true that there are a lot of local "fiefdom silos" and AIPT interoperability issues which would have to be managed. Nonetheless, the current snails pace of AIT adoption will only be accelerated when someone with your capacity and vision steps up, offers a blueprint for integration and collaboration, and shows how everyones bottom lines will benefit from doing so.

I'd be happy to help facilitate such a collaborative effort here in southern Utah.